| NPI | 1184620239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO co2834) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2002018403) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2024-05-05 |